Psychosocial Factors, Stress and Sleep Among Rural Appalachian Kentucky Residents with Type 2 Diabetes Mellitus

Introduction: Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region. Purpose: To better understand these associated health burdens, the relationship among these conditions and psychosocial factors—such as depressive symptoms, distress, empowerment, and social support—was examined among Appalachian residents with T2DM. Methods: Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used to test these associations. Results: Depressive symptoms, distress, and social support were significantly associated with perceived stress, while diabetes empowerment was not associated with perceived stress. None of these psychosocial factors were found to be associated with sleep. Implications: To our knowledge, this is the first known study to examine the relationship among psychosocial factors and perceived stress and sleep in rural Appalachian people with T2DM. With a high prevalence of mental distress in Appalachia, the findings highlight the need to further examine depression, diabetes management, and social support in people with T2DM in rural regions like Appalachia.